improving community based response to cardiac arrest - new zealand

TRANSLATING SCIENCE INTO ACTIONS:IMPROVING CARDIAC ARREST OUTCOMES IN NEW ZEALAND

HEARTSafe Forum For ChangeAuckland, NZ

David B. Hiltz, NREMT-P

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A NECESSARY COMBINATION!

SURVIVAL is the

BENCHMARK for

EMS PERFORMANCE

REGRETABLY…

WE HAVE SOME THINGS IN COMMON

THE MENACE OF SUDDEN CARDIAC ARREST

LOOKING AND SOUNDING FAMILIAR?

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CPR Component Challenges to Improving Quality

Recognition Failure to recognize gasping as sign, unreliable Pulse Detection

Initiation of CPR Low Bystander CPR response Rate, Incorrect Dispatch instructions

Compression Rate Slow compression Rate

Compression Depth Shallow compression Depth

Chest Wall Recoil Rescuer Leaning on Chest

ISSUES SUMMARY 1LOOK LIKE THIS?

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CPR Component Challenges to Improving Quality

Compression Interruptions Excessive interruptions for pulse check, Ventilations, defibrillation, intubation, IV access, other

Ventilations Ineffective ventilations, prolonged interruptions in compressions , excessive ventilations (esp with airway)

Defibrillation Prolonged time to defibrillate avail, prolonged interruptions in chest compressions pre- and post shocks

Team Performance Delayed rotation, leading to rescuer fatigue and decay in compression quality, poor communication among rescuers leading to unnecessary interruptions in compressions

ISSUES SUMMARY 2LOOK LIKE THIS?

THE PEOPLE AREN’T THE PROBLEM!

Many Systems Ideal System

No Data Data Collected

No Plan Quality Improvement Plan

Fragmented Efforts Holistic Approach

Partially Implemented Guidelines

Fully Implemented Guidelines

SYSTEM ISSUESLOOK LIKE THIS?

IMPROVED SURVIVAL

IMPLEMENTATION??LOOK LIKE THIS?

WE NEED A HOLISTIC AND INTERGRATED APPROACH

SURVIVALRECOGNITION

CITIZEN CPRRAPID DEFIB QCPR

POST ROSC

EVOLVING CRITERIA

HEARTBEATS-POPULATION BASED

BRAGGING RIGHTS!

NO FORMAL STRUCTURENO BOARD OF DIRECTORS

NO STAFF

NEARLY 9 MILLION PEOPLELIVING AND WORKING IN HEARTSafe COMMUNITIES

HAVING CHAMPIONS IS ESSENTIAL

IN DEALING WITHANTI-CHAMPIONS!

LOCALIZATIONFOR NEW ZEALAND?

A FEW STEPS (AND A FEW ISSUES)

IN ENDING“SURVIVAL ENVY”

RECOGNITION AND RESPONSETO EARLY WARNING SIGNS?

http://www.youtube.com/watch?v=xZdq-bZ0cV8

TELEPHONE CPR

CITZEN CPR?

LAW ENFORCEMENT

DID YOUR LAST CARDIAC ARRESTLOOK LIKE THIS?

PRACTICE LIKE YOU PLAY?

12 LEADS FOR ACS/POST ROSC?

THERAPEUTIC HYPOTHERMIA?

A CULTURE OF QUALITY?LOOK LIKE THIS?

AN ITERATIVE PROCESS

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HOW ARE HOSPITALS DOING ON THEIR END?

TRANSITION:HIGH PERFORMANCE CPR:

SEATTLE STYLE

“Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR)”

A QUICK REVIEWOF RELATED SCIENCE

DELAYS AND INTERRUPTIONS KILL!

HAVING QUALITY TIME ON THE CHESTIS ESSENTIAL

PRACTICED TEAMWORKMAKES A DIFFERENCE!

EACH PERSON HAS AN ASSIGNED ROLE

AND PRACTICES AGAIN AND AGAIN!

THE MENACE OF SUDDEN CARDIAC ARREST

DRUGS WITH A PROVEN BENEFIT IN RESUSCITATION

HOVERING

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PIT CREW LEADERAIRWAY LEADERDEFIB-IV/IO-MEDSCPR CHIEFCPR DEPUTY CHIEF

*VARIABLE PLAYER

PRE-ASSIGNED ROLES

PRACTICELIKEYOUPLAY

CAN’T WE SOLVE OUR PROBLEMS WITH TECHNOLOGY?

Our Definition!

A provider‐centric process designed to standardize the debriefing process to assist

clinicians in thinking about what they did, how they did it, and how

they can improve.

TRANSITION:Structured and Supported Debriefing

Structured elements include three specific debriefing phases with related goals, actions, and

time estimates.

Structured and Supported Debriefing

B

Thoughtful discussion after an attempted resuscitation is important to facilitate the sorting out of events

as well as gaining insight on what happened and why

We often learn better through self‐discovery

and self‐analysis than by other methods!

•Have long term view•Patients and patience•INSTANT GRATIFICATION!

IMPLEMENTATION

BOY, I AM REALLY

LOOKING FORWARD TO

THE DEBRIEFING

ON THIS CASE!

PROVIDERS NEED TO EXPRESS

THEMSELVES AND THEIR FEELINGS…

AND THIS IS A GREAT FORUM FOR

THAT!

B

B

Team leader trained in Structured

and Supported Debriefings

B

SCONE DIPLOMACY!

NOT PUNATIVE!

B

ROLE OF FACILITATOR

•PROVIDE SAFE ENVIRONMENT FOR SHARING EXPERIENCES

•DRAW OUT INFORMATION AND EXPERIENCES

•CONTENT DIRECTED BY THE CREW

•NEVER JUDGE!

INSTRUMENTED MANIKINS

B

PAVE THE ROAD TO IMPROVED SURVIVAL!

HEARTSafe MORRINSVILLE?

David B. Hiltz401-524-0858

david.hiltz@heart.org

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